Lemierre's Syndrome - Sore Throat Gone Wrong

Written by Clay Smith

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Sometimes sore throat isn’t just sore throat - it could be a life threatening complication. Learn about Lemierre’s syndrome with this quick-hitter teaching case from NEJM.

Why does this matter?
We can get lulled to sleep when patients have sore throat - another strep, another virus. Lemierre’s should be on your differential diagnosis when you see patients with pharyngitis. It is rare but devastating if missed.

Sore throat gone wrong
This was an Images in Clinical Medicine summary, publicly available on NEJM.org (just create a free account). Take a minute to look at this this on the NEJM site. The images are fantastic, and the summary is short.

Briefly, Lemierre’s syndrome is an uncommon complication of pharyngitis usually caused by Fusobacterium necrophorum, an anaerobe, that leads to suppurative thrombophlebitis of the internal jugular vein and subsequent disseminated infection, often with septic pulmonary emboli. It usually presents as a prolonged pharyngitis in a patient who is febrile, appears ill, has asymmetric anterior neck swelling, often pleuritic chest pain, shortness of breath, and often tachypnea with abnormal oxygen saturation. It is diagnosed with CT neck (and usually chest) with contrast. It’s treated with broad spectrum antibiotics that cover anaerobes, such as piperacillin-tazobactam or ampicillin-sulbactam, often in an ICU setting.

Another Spoonful

Source
Lemierre's Syndrome. N Engl J Med. 2019 Mar 21;380(12):e16. doi: 10.1056/NEJMicm1808378.

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Reviewed by Thomas Davis

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